"The triggers are coming, the triggers are coming!"
Miscellaneous
100
This the location that only an FQHC can bill.
What is location 50?
100
These two rehabs bill a location 11, and are not required to bill a rendering provider on claims.
What is Progressive Step Rehab and Betty Hardwick Center?
100
This code is used to Deny a claim when it is Out of Network.
What is DENY 160?
100
This trigger is what you will see when you get a "for sure" COB claim.
What is 32?
100
THSteps claims must bill this modifer when immunizations are billed separately.
What is modifier 25?
200
This is the location that is usually billed by a primary care physician.
What is location 11?
200
This department loads NPI Numbers
What is PDI?
200
This is the UMC used to deny No Authorization on file and Out Of Network in Trigger 6.
What is EXB4?
200
This review is represented by trigger Z7.
What is an NDC trigger?
200
This is the status a claim is in when one or more lines have paid.
What is final?
300
This is the location usually billed for DME.
What is location 12?
300
This is the name of the department that sends out refund request letters.
What is Recovery?
300
This is the UMC to use when denying a claim due to no EOB attached when one is required.
What is EXIL?
300
This trigger represents a review for "attending practitioner not known".
What is trigger 232?
300
****DAILY DOUBLE!!!*****
This is the the department an issue would be need to sent to in order to update the member's file if a sterilization consent form is attached to the claim.
What is Enrollment-Medicaid?
400
This location (not including location 11) is often billed by RHCs.
What is location 72?
400
This is the name of the department that handles COB inquiries.
What is Enrollment-COB?
400
This is the UMC to use when denying a claim due to no NDC billed when required.
What is EXNF?
400
This review is represented by trigger Z4.
What is a review for sterilization consent?
400
This is the Medicaid COB fomula.
HCC=FC fee schedule allowed amount-OI paid amount
500
This location is billed by a land ambulance.
What is location 41.
500
This is the name of the group of providers considered "VIP" and includes RHCs and FQHCs.
What is TORCH?
500
This is the UMC to use when denying a claim that has a valid NDC billed but it does not crosswalk correctly.